Concussion Management: "I've Had Two Myself" An Updated Perspective

Through my experience in 18+ years of team sports at the club, school, and varsity levels, I support that concussions are one of the most mismanaged and misdiagnosed injuries in amateur sport.

But why is this? What really is a concussion, and how can we change this?

What really is a concussion?

Technically classified as a mild traumatic brain injury, a concussion is “a dysfunction in brain cells that happens when the brain undergoes a rapid acceleration and or/deceleration within the skull” [1]. Normal function of the neurons are disrupted and the effects can be devastating. For a more detailed description of concussion mechanisms, check out these great pages from our clinical partners at The Foundation for Integrated Health [2] and Trimetrics Physiotherapy [3]. Both clinics are part of the Complete Concussion Management network.

Because the force of impact the skull receives doesn’t always dictate the severity of the injury, it can be difficult for coaches, parents, players and even doctors to diagnose a concussion and manage the follow-up appropriately.

What you need to know as a coach or parent [1]:

  • Remove athlete from activity immediately, as a second impact can cause exponentially more damage
  • Athlete should be checked out by a professional within 24 hours
  • Symptoms may continue to develop for 3-7 days following injury
  • Though symptoms may disappear, it does not mean the athlete’s brain and neural activity have returned to normal – it may still be in deficit
  • Athlete should not return to practice or play until cleared according to their pre-concussion baseline

Briana’s Story

I’ve had two concussions myself. The first took place while I was an athlete in university and the second occurred while playing field hockey at the club level, two years later. Each case was managed differently, and goes to show some of the recent developments in research and treatment strategy.

My first concussion kept me off school for a month, and almost prevented me from graduating on time. The doctors I saw prescribed rest: basically “wait and see” while they monitored my symptoms using a questionnaire (called SCAT3) to track changes. I spent a lot of time in bed, in a dark room, without electronics or exercise. I was at a low point of physical, mental, and emotional turmoil. Eventually the post-concussive chronic headaches, drowsiness, and sensitivity to light dissipated, but by the time I felt confident to return to sport, three months had passed.

Now, rest is a good initial step on the path to recovery. However, as I learned during the fallout of my second concussion, it is not the ‘be-all-end-all’. There are more proactive treatments that can be taken as tolerated, including manual therapies and the introduction of light exercise and cognitive activity. Following my second concussion, I followed my doctors’ orders and set out to rest. In the post-graduation world, I went on a leave from work but found little improvement after several months. Complete rest did not seem to be working!

At that point, I was introduced to the Foundation for Integrated Health, a North Vancouver clinic within the Complete Concussion Management network. By using cold lasers to “reset” my impaired cranial nerves, Dr. Drake prompted immediate change. I felt clear and energized for the first time in months. The frequency and severity of my concussion symptoms decreased significantly, and I was able to begin my return to life. She guided me through the reintegration of light exercise and cognitive activity, and within another couple months I was feeling 100% and back to work.

Can exercise be part of concussion management and rehabilitation?

Research now shows that exercise is an important part of concussion rehabilitation. Maintaining a “sub-symptom state” is key, but exercising below this threshold promotes cerebral blood flow and lessens physiological dysfunction [5]. Supervision is also important; find a safe space and an exercise professional well-versed in the current concussion research (such as myself, a kinesiologist at it’s time! Fitness Results!)

The final step for me en route to complete return to work, sport, and life was the administration of a Complete Concussion Management baseline test. The clinic put me through rigorous protocol – mental (including memory, cognition, and recognition) and physical (balance with a force plate, grip, reaction time) testing. This type of physical testing, called the Blackhawks Protocol (developed by the NHL’s Chicago Blackhawks medical staff) is objective unlike many of the mental subjective measures (SCAT3 or imPACT testing, often done online through a computer). These online measures are not enough on their own – a physical test is required to gain a full understanding of a person’s progress. The results from my baseline testing are now saved in a database accessible by any trained Complete Concussion Management clinician across Canada – this is the beauty of the system.

What does this mean for you and your kids?

The development of this type of baseline testing at the amateur level is ground-breaking. Before this, clinicians, coaches, parents risked sending the athlete back to play prematurely, placing them in harm’s way. Remember the Ottawan rugby player, Rowan Stringer [4]? Now, all parties can be objectively confident in the return to play decision. This baseline training is accessible (a quick Google search shows 13 clinics in the Greater Vancouver area), affordable (performed by chiropractors and physios, it can be covered under extended health), and can save lives! Bonus – there’s even an app for coaches to track the status of their players who have received baselines.

Unless an athlete has completed a baseline test prior to an injury, there is no way of knowing if their brain has returned to 100%. Concussion symptoms may have disappeared, but the neurons may still be experiencing an energy deficit. If the athlete suffers another hit to the head during this period, they risk prolonged symptoms, permanent brain damage, or even death.

I think the research is in place to eradicate the mismanagement and misdiagnosis of concussions in amateur sport. As coaches, parents, and athletes ourselves, let’s make sure we apply it!

Blog written by: Briana Kelly, Kinesiologist and Strength Coach at it’s time! Fitness Results

Listen to Briana and Sheila discuss this topic on the Jon McComb show’s “Fitness Segment.” Listen live every Thursday at 9:05 am on CKNW 980 am radio.

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Concussion Facts and Treatment